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To assess microstructural and metabolic brain differences between small‐for‐gestational age (SGA) and appropriate‐for‐gestational age (AGA) fetuses at 37 weeks' gestation by magnetic resonance imaging (MRI) spectroscopy and diffusion weighted imaging.

Eight SGA and five matched AGA singleton fetuses, all with normal umbilical artery Doppler, were evaluated using MRI at 37 weeks to measure markers of brain microstructure and metabolism. The metabolic spectrum of N‐acetyl‐aspartate/choline, choline/creatine, inositol/choline and creatine/choline ratios in the left frontal lobe and the apparent diffusion coefficient from the right and left basal ganglia and frontal and occipital lobes, pyramidal tract and corpus callosum were analyzed and compared.

As compared with controls, SGA fetuses showed a significant increase in inositol/choline ratio (SGA, 0.57 vs. AGA, 0.25; P = 0.04 …